Predicting walking as exercise in women with fibromyalgia from the perspective of the theory of planned behavior

Relationship of Pain, Depression, Fatigue, and Sleep Problems with Functional Capacity, Balance, and Fear of Falling in Women with Fibromyalgia: Cross-Sectional Study

(1) Background: Fibromyalgia (FM) is a syndrome marked by chronic widespread pain, fatigue, sleep issues, and other symptoms. Interventions like physical exercise can potentially enhance physical function in individuals with FM. This study aimed to assess physical function, perceived physical fitness, balance confidence, and fear of falling in women with FM based on their levels of pain, depression, fatigue, and sleep problems. (2) Methods: Participants underwent a series of tests and questionnaires to evaluate physical and perceptual aspects. These included the Time Up and Go, Four Step Square Test, 6-Minute Walking Test, Maximum Handgrip Strength, Back Scratch, International Fitness Scale, Activities-Specific Balance Confidence Scale, and Fall Efficacy Scale-International. Participants were categorised by the severity of their pain, depression, fatigue, and sleep problems (mild, moderate, severe). A Kruskal-Wallis test assessed intergroup differences, while Spearman's rho evaluated correlations between the study variables and symptom levels. (3) Results: Perceived physical condition varied significantly with symptom severity. Symptoms and sleep problems were notably linked to fear of falling, though no significant differences emerged in the physical tests. (4) Conclusions: In women with fibromyalgia, symptom severity was primarily related to perceptual and subjective aspects of physical condition and fall safety.

Promoting walking as a self-care strategy in women with fibromyalgia: a cross‑sectional study using accelerometers

INTRODUCTION

Walking is a beneficial healthy lifestyle for fibromyalgia patients as it reduces the intensity of pain and fatigue experienced and improves quality of life. In this context, self-efficacy and commitment are potential predictors of walking for women with fibromyalgia. Present study aims at examining the moderation role of exercise commitment in the association between self-efficacy for walking and walking behavior in this population.

METHOD

It is a cross‑sectional study. A total of 132 women with fibromyalgia participated (mean age = 57.63, SD = 10.44) between January and December 2018. Self-efficacy about walking was assessed through Spanish version of self-efficacy scale for physical activity scale (SEPAS) and exercise commitment through ad-hoc questionnaire (two Likert-type items about the committed action of physical activity). Walking behavior was measured using accelerometers for seven consecutive days. Pain and fatigue prior to placement of the accelerometer were evaluated as possible covariates. Regarding medical history, time since onset of symptoms (i.e. pain, fatigue) and since diagnosis, and medication were also assessed as possible covariates.

RESULTS

A moderation effect of exercise commitment was found in the relationship between self-efficacy on walking behavior (B = 10.48, p = .021, 95%, CI = 0.61 to 6.79). Post-hoc analyses showed a significant and positive relationship between self-efficacy and walking only with high commitment to physical activity (t = 10.08, p = .027, 95%, CI = 3.77 to 5.64).

CONCLUSIONS

Self-efficacy for walking and commitment should be assessed and potentially targeted when focusing on increasing walking in women with fibromyalgia. Key Points • Associations between walking self-efficacy and exercise engagement provide indications of modifiable targets for promoting an active lifestyle in fibromyalgia. • When patients feel engaged in their physical exercise pattern (walking), patients feel more able to perform the behavior. • Rehabilitation interventions, focused on chronic pain, should contemplate the promotion of self-efficacy and engagement.

Physical activity correlates in people with fibromyalgia: a systematic review

PURPOSE

Understanding the enablers of and barriers to physical activity (PA) participation in people with fibromyalgia (PwF) is an essential first step to developing effective PA interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental, and policy level) in PwF.

MATERIALS AND METHODS

PubMed, Embase, and CINAHL were searched from inception until 12 July 2022. Keywords included "physical activity" or "exercise" and "fibromyalgia" or "fibrositis." Summary coding was used to quantify the PA correlates.

RESULTS

Out of 74 PA correlates retrieved from 39 articles (n = 9426), co-morbid depression and higher pain intensity were found to be consistent (i.e., reported in four or more articles) barriers to PA in PwF, while higher self-efficacy and better endurance were found to be consistent enablers to PA. Despite the abundance of evidence for the PA benefits for PwF, we only found consistent evidence for PA correlates at the intrapersonal level.

CONCLUSIONS

Health professionals should consider mental and physical health barriers when promoting PA in PwF. There remains a need to better understand social, environmental, and policy-related factors associated with PA participation in PwFImplications for rehabilitationCo-morbid depression is a notable barrier to physical activity participation in people with fibromyalgia.Experienced pain intensity should be considered as a barrier when promoting physical activity for people with fibromyalgia.Rehabilitation professionals should facilitate self-efficacy in physical activity interventions for people with fibromyalgia.Rehabilitation professionals should promote endurance when motivating people with fibromyalgia towards an active lifestyle.

Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia

OBJECTIVES

To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM).

SETTINGS

Open-label, feasibility clinical trial.

PARTICIPANTS

Eleven people with FM (10 women).

INTERVENTIONS

The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention.

RESULTS

One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation.

CONCLUSIONS

This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support.

TRIAL REGISTRATION NUMBER

NCT03764397.

The Role of Self-Efficacy and Activity Patterns in the Physical Activity Levels of Women with Fibromyalgia

Keeping high levels of physical activity is a challenge among chronic patients. In this regard, self-efficacy has been identified as a crucial variable to reduce sedentarism and physical inactivity in women with fibromyalgia. The current study aimed to evaluate the associations among objective physical activity levels, self-efficacy, activity patterns, and the impact of the disease, as well as to compare those variables between women with fibromyalgia with different self-efficacy levels. For this purpose, in this cross-sectional study, the physical activity levels of 123 women with fibromyalgia were assessed by accelerometers, together with self-efficacy, the impact of the disease, and activity patterns. Results revealed that self-efficacy for light or moderate physical activity was directly related to light (p < 0.01), moderate (p < 0.01), and vigorous physical activity (p < 0.05), as well as inversely related to sedentary time (p < 0.01). Moreover, the main differences were observed between those with low self-efficacy levels and the rest of the sample, while there were no differences between the high and the medium self-efficacy groups (p > 0.05). Thus, self-efficacy for walking and light physical activity seems to be more relevant than self-efficacy for moderate and vigorous physical activity to achieve higher levels of physical activity.

Symptoms in women with fibromyalgia after performing physical activity: the role of pain catastrophizing and disease impact

INTRODUCTION

Walking is an effective treatment for symptoms' management in patients with fibromyalgia. However, despite its benefits, fibromyalgia patients face a variety of obstacles that result in reduced ability to sustain physical exercise. The main goal of the study was to analyze the role of pain catastrophizing and fibromyalgia impact in the relationship between regular walking behavior and pain and fatigue experienced after a laboratory walking test.

METHOD

The study has an observational analytical laboratory design. A total of 100 women were contacted by the research team. Seventy-six women diagnosed with fibromyalgia aged 18 years and older (mean age = 55.05, SD = 7.69) participated.

RESULTS

Significant correlations were found among regular walking behavior, pain catastrophizing, impact of fibromyalgia, pain intensity after walking, and fatigue intensity after walking. The serial multiple mediation analyses confirmed that pain catastrophizing and impact of fibromyalgia mediated the relationship between regular walking behavior and the level of pain (beta B = 0.044, 95% CI = [0.01-0.012]) and fatigue (beta B = 0.028, 95% CI = [0.01-0.08]) after the laboratory walking test. Also, the participants that walked less regularly experienced more pain and fatigue after the 6-Minute Walk Test.

CONCLUSIONS

Considering cognitive variables alongside the impact of fibromyalgia will help understand the inhibitors of engaging in physical activity. Therapeutic walking programs must be tailored to patients with fibromyalgia to reduce pain and fatigue related to physical activity and to promote better functioning and quality of life. Key Points • Regular walking behavior was associated with fibromyalgia impact, pain catastrophizing, and less pain and fatigue after physical activity. • When patients catastrophize pain, they usually interpret physical activity as threatening, which generates more pain and fatigue after doing exercise. • Therapeutic programs should be designed to reduce pain catastrophizing and fibromyalgia impact.

Predicting Adherence to Walking from Anxiety, Depression, Disease Impact, Catastrophizing, and Cognitive Fusion in Patients with Fibromyalgia: Does Pain Severity Matter?

AIM

This study analyzed whether the contribution of several factors associated with walking adherence in fibromyalgia (FM) patients varies across pain severity levels.

METHODS

Participants were 228 women with FM (mean age 57 years; SD = 8.49).

RESULTS

Bivariate analyses replicated the expected association between predictors (FM impact, anxiety, depression, catastrophizing, and cognitive fusion) and poorer adherence to walking. Multivariate analyses showed a negative contribution of FM impact, catastrophizing, and depression on walking adherence after controlling for pain levels (all p < 0.01). A moderation effect of pain severity in the relationship between predictors and adherence to walking was only found for cognitive fusion (B = -0.01, t = -2.02, p = 0.040). Specifically, cognitive fusion only contributed to poor walking adherence at moderate and severe pain levels, but not when pain was mild. The contribution of the remaining predictors was not moderated by pain levels, which means that they contributed to walking adherence irrespective of the pain severity of the patient. Pain severity did not contribute to walking adherence when controlling for the predictors.

CONCLUSION

Clinical implications are discussed from the perspective of personalized interventions and preferable target interventions when attempting to increase adherence to walking in this population.

Factors influencing patient delay in individuals with obstructive sleep apnoea: a study based on an integrated model

BACKGROUND

Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder, yet it remains undiagnosed in a large proportion of adults.

OBJECTIVE

This study aims to investigate the status of patient delay and provider delay in OSA patients and examine related factors affecting patient delay in OSA individuals in China.

METHODS

A cross-sectional design was conducted on a sample of 309 OSA patients (aged from 18 to 76, median age of 47 years, 84.8% male) in Northeast China. Participants were required to complete the sociodemographic questionnaire, the symptom characteristics questionnaire, the help-seeking attitude scale (HSAS), the social support rating scale and the chronic disease self-efficacy scales (CDSES) to test the hypothesis. Binary logistic regression analysis was conducted to explore factors that account for the patient delay.

RESULTS

The median patient delay among OAS patients in this study was 22 months, the median provider delay was one month, and the median total delay was 26 months. As shown by multivariate analysis results, patients who have snored for over 6 years (OR = 3.377, 95%CI: 1.175-9.702) were more likely to experience prolonged patient delays. Per capita monthly family income above 3000 RMB (OR = 0.172, 95%CI: 0.052-0.571), taking up residence in cities or towns (OR = 0.484, 95%CI: 0.248-0.946), higher self-recognition of the disease (OR = 0.793, 95%CI: 0.647-0.972), higher objective support (OR = 0.825, 95%CI: 0.739-0.921) and stronger self-efficacy (OR = 0.674, 95%CI: 0.525-0.867) were significantly associated with shorter patient delays.

CONCLUSION

Patient delay is common in Chinese OSA patients. The upstream factors affecting the patient delay in individuals with OSA include income, place of residence, and objective support; midstream factors include self-recognition of the disease and self-efficacy; downstream factors include years of snoring.KEY MESSAGESDespite being a high-prevalence disease, many obstructive sleep apnoea (OSA) patients are not clearly diagnosed and treated.The factors affecting the delay in seeking medical treatment in individuals with OSA included income, place of residence, objective support, self-recognition of the disease, self-efficacy and years of snoring.Investigations into OSA patients' care-seeking behaviours can better reflect the secondary prevention of OSA, and it is crucial to pay attention to the delayed phase of patients.

Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

Predictors of Physical Activity in Patients With Fibromyalgia: A Path Analysis

BACKGROUND/OBJECTIVE

The aim of this study was to identify psychological factors that influence moderate-vigorous physical activity (MVPA) participation in patients with fibromyalgia.

METHODS

In this secondary data analysis, 170 patients received personalized exercise plans and completed baseline and follow-up assessments of self-reported physical activity at weeks 12, 24, and 36. Structural equation modeling was used to examine the predictive strengths of psychological factors (exercise self-efficacy, perceived barriers, and intention) on MVPA participation.

RESULTS

Using a threshold increase in MVPA of 10 or greater metabolic equivalent hours per week (MET h/wk), 3 groups were defined based on subjects who achieved a minimum increase of 10 MET h/wk that was sustained for at least 12 weeks (SUS-PA), achieved an increase of 10 MET h/wk that was not sustained for at least 12 weeks (UNSUS-PA), and did not achieve an increase of 10 MET h/wk (LO-PA). Increases in exercise self-efficacy and intention and reductions in perceived barriers were associated with increased volume of PA, showing the greatest change in the SUS-PA, followed by UNSUS-PA. For the LO-PA group, there was no change in exercise self-efficacy, a decrease in intention, and an increase in barriers. Using path analysis, exercise self-efficacy and perceived barriers were associated with higher volumes of physical activity via greater intention to engage in MVPA.

CONCLUSIONS

For patients with fibromyalgia, exercise self-efficacy, perceived barriers, and intention to exercise are important constructs for increasing physical activity. Our findings provide guidance for practitioners who seek to promote physical activity in fibromyalgia and suggestions for researchers aiming to improve prediction models.

Exploring the Preference for Fatigue-avoidance Goals as a Mediator Between Pain Catastrophizing, Functional Impairment, and Walking Behavior in Women With Fibromyalgia

OBJECTIVES

Along with the symptoms of pain and fatigue, pain catastrophizing and avoidance behaviors are highly prevalent and associated with functional impairment in fibromyalgia (FM) patients. Although pain and fatigue affect patients' quality of life, research has been exclusively focused on how pain affects physical activity and exercise. The aim of this study was to analyze the role of pain catastrophizing and preference for fatigue-avoidance goals in walking behavior and functional impairment in women with FM.

MATERIALS AND METHODS

In this cross-sectional study the sample was composed of 76 participants aged 18 years and older (mean age=55.05, SD=7.70). The study evaluated pain catastrophizing, preference for fatigue-avoidance goals, functional impairment, and walking behavior along with sociodemographic variables and clinical data.

RESULTS

Pain catastrophizing was associated with preference for fatigue-avoidance goals and this preference was associated with greater functional impairment and less distance walked. Path analysis supported the mediating role of preference for fatigue-avoidance goals in the relationship between pain catastrophizing and walking behavior and between pain catastrophizing and functional impairment. Furthermore, pain catastrophizing predicted greater preference for fatigue-avoidance goals which predicted more problems in functioning and less distance walked.

DISCUSSION

The present study may help clarify the connection between the factors that stop individuals with FM from implementing beneficial behaviors such as walking, and thus, allowing for the design of psychological interventions that seek to maintain physical functioning despite experiencing fatigue.

Assessing Self-Efficacy for Physical Activity and Walking Exercise in Women with Fibromyalgia

BACKGROUND

Exercise and physical activity are an evidence-based practice for chronic pain. Health professionals need instruments to assess self-efficacy for this practice taking into account the specific barriers of patients with these health problems.

PURPOSE

To develop and test the psychometric properties of a new self-efficacy scale for physical activity and walking exercise in patients with fibromyalgia.

DESIGN

A cross-sectional and prospective study was conducted in a Spanish Fibromyalgia Unit. Two hundred and eleven new patients signed the informed consent and participated in the study. All of them were women, referred to by either Primary or Specialized Health Care. In addition to the new scale, they filled out several self-reported and validated instruments to collect the data present in this study.

RESULTS

Exploratory factor analysis showed a three-factor model (GFI = .99; RMSR = .06) that explained 74.2% of the total variance. They assessed how confident patients felt about walking quickly in both 30- and 60-minute sessions, (Factor I: 10 items; α = .97), to perform daily physical activities (Factor II: 10 items; α = .93) and to undertake moderate physical activity (Factor III: 5 items; α = .95). The total score of the scale and the three-factor scores showed good criterion validity and adequate validity based on the relationships with other constructs.

CONCLUSIONS

The scale showed adequate psychometric properties and can be a useful tool to help health professionals monitor patients' self-efficacy perception and customize both physical activity and walking exercise intervention goals and their implementation.

Promoting unsupervised walking in women with fibromyalgia: a randomized controlled trial

The objective of this study is to test the efficacy of a group motivational plus implementation intentions intervention in promoting adherence to an unsupervised walking program recommended for fibromyalgia, compared to an implementation intentions condition and to an active control condition. A triple-blind, randomized, longitudinal study with measures at baseline, short (seven weeks post-intervention), mid (12 weeks) and long-term (36 weeks) is performed. Data are analyzed using multilevel longitudinal growth curve two-level modelling. Participants are 157 women with fibromyalgia. In the short-term, adherence to the minimum and to the standard walking program (primary outcome measures) is explained by time (both p <.001), motivational plus implementation intentions intervention (both p <.001) and by their interaction (both p <.001). Regarding the secondary outcomes, only physical function is explained by time (p <.001), motivational plus implementation intentions intervention (p <.05) and by their interaction (p <.05). Motivational plus implementation intentions intervention achieve the promotion of walking as an exercise in the short-term; furthermore, physical function of the women in this condition is better than in the other two intervention groups, which is a relevant outcome from a rehabilitation point of view. However, more studies are needed to maintain the exercise at mid and long-term.